This project argues that deceptions are worth studying as creative acts. The resulting discoveries are applied to discourses within contemporary narrative illustration. Almost all complex deceptions are texts composed of visual and verbal elements. This research is interested in those deceptions that appear in print and particularly those that involve the creation of a fictional author through a sustained text meant to be considered real by a particular audience. The deceptions concerning this research are not momentary; they exist as specially created artefacts and documents and are sustained over a substantial period of time. These deceptions are not necessarily created by artists or authors, they may be created by any person who utilises a particular methodology: the appropriation and collage of visual and narrative fragments to create the illusion of a seamless whole. The images in these deceptions respond to the Internet and fragmentary, circular or real time narrative in a way that mainstream illustration, as yet, does not. The research methodology is empirical; evidence of the deceptions’ dissemination and repetition is collected. These are the texts; the illustrated fictions analysed by the thesis. The taxonomy organises them according to their aesthetic characteristics, avoiding psychological speculation and focusing on their substance. The concept of ‘fake literature’ within literary theory and the increasing use of strategies amongst artists that question discredited notions of authenticity are also considered. Certain philosophical theories about the nature of language are used to clarify the discussion.

This practice-led research examines the paradox of seamlessness in fashion, drawing on the similarities found between the process of making garments, the process of their embodiment and process of research. Integrating practical and theoretical methods, it suggests that the process of making and using garments can be a transitional experience, as well as a device that creates ambiguity of subjectivity, which in turn promotes the subject’s reflexive re-adjustment. This analysis informed and was informed by making a series of seamless woven garments which reveal their own construction, showing themselves to be forms in process, representing the ambiguity of modern subjects. Inconsistency and contradiction are intrinsic to fashion: it is both matter and meaning, both cover and display, both imitation and differentiation, but it is always difficult to locate clear demarcation. As a garment-maker, I metaphorically placed this ambiguity at the material level of seams, openings and edges of garments, from which emerged the research question: What is the meaning and function of the seam and seamlessness? My investigation through making garments via hand-woven seaming methods, and my search for an adequate theoretical rendering of the reflections arising from the making, led me beyond the discipline of fashion, to the fields of psychoanalysis, anthropology, sociology and art, literary and cultural theory, from which a series of perspectives are derived. Articulated in this thesis and the accompanying exhibition are thus the process and result of my explorations through making, writing, and theory. The making process involving contact with material is a displacing experience that generates a reflexive value. This demonstrates the ability of garments to test and reset the essential boundary of corporeal subjectivity through the experience of both illusion and reality. Dressing practice is thus the making of the self via repeated reality testing. The poetic function of making thus enables us to generate an authentic knowledge from the experience of oscillating between disparate states. Therefore, together, the seam and seamlessness represent the subject-in-process, and fashion as a particular way of being in this transitional passage. The estranging effect of my hand-woven seams demonstrate this poetic function of making. In the same way, the thesis reveals the seams between practice and theory, and between diverse references, but also their mutually informing relationship.

As part of a high quality nursing student experience within Higher Education there is a need to access the voice of the student. By listening to the students, greater clarity and understanding from the students' perspective is proposed. The focus of this research is within the first year of an undergraduate nursing programme. This thesis gives insight into the experiences and perceptions of undergraduate nursing students' transition into Higher Education and professional transformation, within the first year of a three year proframme. In addition, the research sought to illuminate the participants' personal learning journeys and experiences. There is a dearth of literature addressing various aspects of the first year student experience and minimal literature which represents the student voice. The first year experience is a complex and multifaceted area of study. This complexity is related to the Higher Education organisational processes that are required to enable the student to succeed and the amount of personal investment by each student who enters programmes of learning within a university setting. It has been identified that the first year is the most critical to ensuring that students engage with programmes of learning and achieve both academically and professionally (Trotter and Roberts 2006). To develop insight into the learner's journey a theoretical framework is constructed from within an interpretive paradigm. Hermeneutic phenomenology was selected as a suitable methodology for this research, informed by the work of Max van Manen (1990). The use of hermeneutic phenomenology enable the exploration of participants' experiences. The participants in this research were representative of a typical nursing cohort's profile and, therefore, provided the ideal means of investigating the student nurse experience within the first year. Ten student nurses volunteered to participate in this research and data was collected over a period of one year by use of repeated semi-structured interviews and collection of critical incidents using digital voice recorders. Data was analysed using phenomenological and hermeneutic strategies involving in-depth, iterative reading and interpretation to identify themes in the data. Findings from this research identify that the students have developed skills to survive but there was considerable variation in the student experience which impacted on their motivaton and behaviour. A key finding was the ability of students to develop their own skills of coping to deal with the demands of academic life and those of the practice settings. The skills of self-reliance and self efficacy are evident in the findings and are explored in relation to professional transformation.

No description available.

There are clear indications that over the coming years, as more people live longer with life limiting illnesses an increasing amount of support for carers of service users with palliative care needs will be required. Respite care is often described in UK policy and guidance as a key need in providing this support and yet little is known about it for patients with life limiting illnesses and there is a lack of research to support its efficacy. The purpose of this research was therefore to establish whether respite care addresses the needs of palliative care service users and carers. The approach was qualitative and the methodology was interpretive. The method used was constructivist Grounded Theory. This provided high compatibility with the theoretical underpinnings which were learning from the experiences of service users and carers, embracing the principles of critical practise and learning through relational endeavour. Data collection was carried out by unstructured informal interview with three couples and two bereaved carers who had experienced hospice respite care. The participants were interviewed on two occasions and social network circle activity was undertaken as part of theoretical sampling. Findings showed that respite care is valued by palliative care service users and carers although there are some fundamental tensions in service models which limit its potential. A theory of vulnerability and resilience was developed which accommodated issues of needs and acceptance, choice and risk, loss and gains. A reframing of respite care as an empathic response within a new palliative care approach is proposed. Within this the centrality of the relationship is reinforced and the need for support over a potentially long and more uncertain illness trajectory is acknowledged. The articulation of respite care needs and the insights gained in this study have the potential to influence practice and provide a platform for innovative service development and improvement.

Poor quality and unrefreshing sleep is one of the most common symptom complaints in Chronic Fatigue Syndrome (CFS). Despite this, the links between sleep dysfunction and CFS are not well understood, and there has been an absence of good quality research into the nature of sleep problems in CFS, which also lack consistency in the data reported. However, it remains plausible that sleep problems may help to maintain and exacerbate other existing symptoms. Given the dispute in models ranging from the biological to the psychological, competing to explain symptomology, it is a critical time by which we try to understand the relationship between poor sleep, fatigue, endocrine activity and CFS, in an attempt to shortcircuit this debate. With an aim to redress this, this thesis intended to examine the role of sleep from several angles, utilizing a range of assessment methods; Study 1 addressed the lack of in depth qualitative interview studies, to understand the extent to which sleep, its management and problems, are linked to the lived experience of CFS, and how it interacts with other symptoms (chapter 3). Patient narratives demonstrated that sleep disturbances experienced were highly unpredictable and variable over time, but played a key role in symptom maintenance; Study 2 examined self-reported sleep (via sleep diaries) in CFS patients, exploring whether sleep quality and daytime napping had an impact on daytime fatigue, sleepiness and cognitive functioning (key dimensions of the illness experience) (chapter 4). The results were highly variable but indicated that afternoon-evening napping was associated with greater impairment in daytime cognitive functioning in CFS patients. It was also evident that CFS patients with longer wake time and a shorter diagnosis had more severe fatigue; Study 3 explored the possibility that sleep problems in this population are not homogeneous and revealed four sleep-specific phenotypes to exist, which are amenable to different treatment approaches. The initial cross-sectional examination of single-night polysomnography (PSG) data identified 30% of the sample had a primary sleep disorder (PSD), which underscores the need to assess for PSDs in CFS populations (chapter 5); Study 4 was conducted to address the principle aim of this thesis; to determine the feasibility of a detailed, 3-night sleep assessment protocol in a small cohort of CFS patients. By utilising iv a range of methods including ambulatory PSG and a gold-standard protocol for sampling of diurnal salivary cortisol, the study piloted the most comprehensive assessment of sleep ever attempted in a CFS population. The findings established a successful protocol that was acceptable to patients (chapter 6), a key advancement in this field where effective and thorough sleep assessment is needed. Preliminary sleep data confirmed a notable variability of sleep problems to exist. Further, the temporal stability of sleep variables was established; sleep continuity (sleep duration, wake duration, sleep efficiency) and main architectural (sleep stages) parameters were consistent across two nights of assessment (chapter 7). The results presented in this thesis indicate that disturbed sleep is a major problem for patients with CFS, albeit highly variable between and within individuals. The identification of sleep phenotypes also confirms the heterogeneity of sleep in CFS. Interestingly, light sleep and arousability was a recurring sleep characteristic in patients that was mirrored by the studies presented throughout the thesis, highlighting a potential autonomic component. This should be a consideration for forthcoming work, along with the possibility that sleep disturbances may mediate the maintenance and exacerbation of symptoms, fuelling a reciprocal cycle that keeps the condition going. The preliminary findings presented throughout this trajectory of research will help to form the systematic development of a sleep characterisation and intervention programme. With this field moving towards more patient-centred medicine and tailored treatments, by combining data from the objective and subjective sleep measures, we aim to design a definitive multicentre study, using sleep-specific interventions, amenable to the four phenotypes identified. The long-term goal is to improve treatments that will enhance symptom management, which is crucial in this condition, at least until the CFS research understands the pathogenesis of this debilitating disease.

Background: The MMSE is commonly used as a screening instrument for cognitive impairment in stroke services. However, recent research has shown that it has poor diagnostic validity for use in this patient population. The purpose of this study was to examine the validity of the ACE-R as an alternative screening measure for use in stroke. Objectives: The first objective was to determine whether the ACE-R is more accurate than the MMSE at detecting overall cognitive impairment in stroke. The second objective was to determine the accuracy of the ACE-R subscales for detecting impairments in specific cognitive domains. Methods: This study had a cross-sectional design. 40 patients were recruited from an inpatient stroke service. They were administered the ACE-R (which includes the MMSE), and a battery of more detailed neuropsychological tests, which served as the ‘gold standard’ for classification of impairment. The diagnostic validity of the ACE-R and MMSE was determined by ROC analysis. Results: Both the MMSE and the ACE-R were found to have inadequate diagnostic validity for the detection of overall cognitive impairment. No cut-scores scores could be identified which yielded test sensitivity of >80% and specificity of >60%. Levels of specificity were particularly poor. The ACE-R subscales showed a similar pattern of performance, indicating inadequate validity for the detection of impairment in specific areas of cognitive functioning. Conclusions: There was no support for the use of the MMSE or the ACE-R when screening for cognitive impairment in acute stroke. Further research should focus on the identification of an alternative measure.

Background: The MMSE is commonly used as a screening instrument for cognitive impairment in stroke services. However, recent research has shown that it has poor diagnostic validity for use in this patient population. The purpose of this study was to examine the validity of the ACE-R as an alternative screening measure for use in stroke. Objectives: The first objective was to determine whether the ACE-R is more accurate than the MMSE at detecting overall cognitive impairment in stroke. The second objective was to determine the accuracy of the ACE-R subscales for detecting impairments in specific cognitive domains. Methods: This study had a cross-sectional design. 40 patients were recruited from an inpatient stroke service. They were administered the ACE-R (which includes the MMSE), and a battery of more detailed neuropsychological tests, which served as the ‘gold standard’ for classification of impairment. The diagnostic validity of the ACE-R and MMSE was determined by ROC analysis. Results: Both the MMSE and the ACE-R were found to have inadequate diagnostic validity for the detection of overall cognitive impairment. No cut-scores scores could be identified which yielded test sensitivity of >80% and specificity of >60%. Levels of specificity were particularly poor. The ACE-R subscales showed a similar pattern of performance, indicating inadequate validity for the detection of impairment in specific areas of cognitive functioning. Conclusions: There was no support for the use of the MMSE or the ACE-R when screening for cognitive impairment in acute stroke. Further research should focus on the identification of an alternative measure.

Background Sensory sensitivity (SS) is defined as the level to which an individual is able to regulate their responses to sensory input. Children with Autistic Spectrum Disorder (ASD) have been found to display unusual and abnormal levels of SS. These variabilities in SS have been associated with poorer levels of adaptive behaviour, behavioural difficulties and emotional problems. Parental questionnaires are frequently used to assess children’s SS. However concern has been raised regarding the use of parents as the sole informant. This study aimed to assess whether parental reports of children’s SS were consistent with alternative informants’ (school staff) reports. Methods The Short Sensory Profile (SSP: Dunn, 1999) was administered to 72 pairs of parents/caregivers and school staff, to be completed for children with ASD (aged 4 to 18 years). This 38 item questionnaire highlights variations of sensory modulation and provides a total score, and 7 factor/subsection scores relating to different aspects of sensory processing (e.g. auditory filtering). This study utilised intraclass correlation coefficient (ICC) values to assess the level of agreement.

In 2011 it was estimated that in Thailand there were 498,800 stroke survivors of both sexes but most were over the age of 65. They were served by only 625 occupational therapists (OTs). Occupational therapy (OT) plays a key role in the rehabilitation service for stroke patients, in particular, by enabling stroke survivors to reengage with activities of daily living and to resume work or family tasks. OT needs to be culturally appropriate and relevant to the therapists, stroke patients and their families. The Occupational Therapy Mahidol Clinic System (OT-MCS) has been designed to be culturally relevant and is based on collaborative teamwork which can better address the needs of the stroke patients. OT-MCS was introduced in 6 regional OT clinics. This study compared perceptions of stroke clients who took part in the new approach 8 weeks before and during the rehabilitation. One hundred and twenty stroke participants were divided into 2 functional groups (slow and fast stream rehabilitation). Stroke participants (N=120) and OTs (N=60) explored the arrangement of activity items into domains for creating a new activity card sort (ACS). Sixty stroke participants (slow stream rehabilitation) and 60 OTs were surveyed to investigate the attitudes of “satisfaction” and “importance” via 40 therapeutic activities. Sixty stroke participants (fast stream rehabilitation) evaluated the levels of their activity engagement in diverse cultural-therapeutic activities. Lastly, 23 stroke participants (slow and fast stream rehabilitation) were interviewed in order to ascertain their lived experiences after the use of OT-MCS and the data were analysed using thematic analysis. The integrated analysis demonstrated strong satisfaction and engagement with OT-MCS. The use of the activity catalogue met with positive attitudes from the stroke participants and in particular the collaborative approach of OTs and participants gave meaning to the activities and a sense of self management. In addition in the fast stream rehabilitation participants reported satisfaction with the transferability of the activities to the home and external environment and their relevance to supporting family life. The OT-MCS for Thai stroke rehabilitation is a comprehensive OT service, which improves the perception of benefit in stroke clients enabling them to perform meaningful and purposeful activities based on their local and regional lifestyles. This culturally appropriate approach helps stroke clients to re-develop their life-skills. Through the use of meaningful and relevant activities which meet their specific needs, stroke clients can lead more satisfying and fulfilling lives.